I saw this on another list today and thought you might be interested.
Nina
Ask the Experts about Insomnia
From Medscape Primary Care
The Impact of Disturbed Sleep on Pain
Question
What is the impact of disturbed sleep on pain?
Response from Thomas Roth, PhD
Professor, Department of Psychiatry, Wayne State University College of
Medicine, Detroit; Director, Sleep Disorders Center, Henry Ford Hospital,
Detroit.
A variety of sleep disturbances, including difficulty falling asleep and
frequent nocturnal awakenings, are commonly reported by patients
experiencing pain. Even among pain patients not reporting frequent
awakening, reports of nonrefreshing sleep are common. Sleep laboratory-based
studies in patients with acute pain (eg, postoperative patients), as well as
in patients with chronic pain (eg, neuropathic pain and rheumatologic
conditions), show frequent arousals, difficulty falling back to sleep after
nocturnal awakenings, and a reduced time spent in REM sleep.[1]
Clearly, pain causes sleep disturbances. However, it is becoming
increasingly clear that these sleep disturbances result in an increased
sensitivity to pain, thereby setting up a cycle of pain leading to disturbed
sleep which, in turn, leads to more pain.[2] Both the loss of REM sleep,
even for 1 night, and partial sleep deprivation can lead to increased pain
sensitivity.[3-5] A loss of sleep as small as 4 hours over 1 night results
in a significant decrease in pain threshold.[6] Although 4 hours of sleep
loss for a night may seem extreme, it is important to remember that the
consequences of sleep loss accumulate across nights. Thus, 1-2 hours of
sleep loss across 2-4 nights would have the same effect. Furthermore, it may
not simply be disturbed sleep that exacerbates pain. The administration of
opiates to alleviate pain may turn out to be counterproductive, as these
medications are REM suppressants, and loss of REM sleep increases pain
sensitivity, as noted earlier. Thus, t!
he preservation of sleep time and sleep architecture are important parts of
pain management. Interventions such as maximizing the sleep environment in
postoperative and other hospital patients as well as the use of behavioral
and pharmacologic treatment to manage insomnia in chronic pain patients are
important aids in the management of pain. Finally, insomnia clinical trials
in comorbid pain conditions should measure treatment efficacy, not only in
terms of sleep, but also in terms of pain control and the need for
analgesics.
References
Menefee LA, Cohen M, Anderson WR, Doghramji K, Frank ED, Lee H. Sleep
disturbance and nonmalignant pain: a comprehensive review of the literature.
Pain Med. 2000;1:156-172. Abstract
Affleck G, Urrows S, Tennen H, Higgins P, Abeles M. Sequential daily
relations of sleep, pain intensity, and attention to pain among women with
fibromyalgia. Pain. 1996;68:363-368. Abstract
Moldofsky H, Scarisbrick P. Induction of neurasthenic musculoskeletal pain
syndrome by selective sleep stage deprivation. Psychosom Med. 1976;38:35-44.
Abstract
Moldofsky H, Scarisbrick P, England R, Smythe H. Musculoskeletal symptoms
and non-REM sleep disturbance in patients with "fibrositis syndrome" and
healthy subjects. Psychosom Med. 1975;37:341-351. Abstract
Lentz MJ, Landis CA, Rothermel J, Shaver JL. Effects of selective slow wave
sleep disruption on musculoskeletal pain and fatigue in middle aged women. J
Rheumatol. 1999;26:1586-1592. Abstract
Roehrs TA, Blaisdell B, Greenwald MK, Roth T. Pain threshold and sleep loss.
Sleep. 2003;26(suppl):A196.
Funding Information
Supported through an educational grant from Sanofi-Synthelabo Inc., a member
of the sanofi-aventis Group.
Disclosure: Thomas Roth, PhD, has disclosed that he has received grants from
Aventis, Cephalon, GlaxoSmithKline, Neurocrine, Pfizer, Sanofi, Sepracor,
Somaxon, Syrex, and Takeda. Dr. Roth has also disclosed that he has served
as a consultant for AstraZeneca, Aventis, Cephalon, Cypress, Eli Lilly,
GlaxoSmithKline, Hypnion, King, Lundbeck, McNeil, Merck, Neurocrine,
Organon, Orginer, Pfizer, Roche, Sanofi, Sepracor, Somaxon, Syrex, Takeda,
Transoral, Vivometrics, and Wyeth, and as a speaker for Sanofi.